| NPI | 1891857074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist Orofacial Pain (Licence: MD D15884) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 15884) |
| 122300000X Dentist (Licence: MD 15884) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2024-01-23 |