NPI | 1043803612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 14031) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA DN122889) |
Enumeration Date | 2021-02-15 |
Last Update Date | 2025-10-02 |