| NPI | 1831563832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: CA DDS108250) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009135) |
| Enumeration Date | 2015-11-15 |
| Last Update Date | 2024-10-22 |