| NPI | 1003558511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0442000450) |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-08-01 |