| NPI | 1912923855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: MI 2901015677) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 0015677) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901015677) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: MI 0015677) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-08-08 |