| NPI | 1033544010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA S-939) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRP1249) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2018-06-08 |