| 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 |