| NPI | 1932656659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: NV 8049) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 000086) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1857430) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV 8049) | |
| Enumeration Date | 2016-09-11 |
| Last Update Date | 2024-08-16 |