| NPI | 1871010165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: NC 14049) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 14049) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2025-06-18 |