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 |