| NPI | 1093391518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 7616) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA DR61164243) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2022-06-24 |