| NPI | 1891846515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: NY 45850-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 013564-1) |
| 122300000X Dentist (Licence: NY 045850-1) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2019-10-09 |