| NPI | 1225561061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OK 234) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7760) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2024-03-05 |