| NPI | 1053874297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.027678) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35607) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 35607) | |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2024-08-02 |