| NPI | 1902850738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist Orofacial Pain (Licence: MN D9334) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D9334) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-03-16 |