| NPI | 1982681771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X2210X Dentist, Orofacial Pain (Licence: VA VA0401416696) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12080) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2019-12-05 |