| NPI | 1891103321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: AZ 8969) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 8969) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2024-03-25 |