| NPI | 1043537707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD157371) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR D10084) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2020-10-02 |