| NPI | 1912487265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: CA DDS102908) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CA DDS104403) |
| 125Q00000X Oral Medicine (Licence: CA DDS102908) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: MN R862) | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2026-05-15 |