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 |