| NPI | 1922678739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: MA DN10000108) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN10000108) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2026-08-16 |