| NPI | 1235332834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD154906) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME16886) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 21547) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OR D9059) | |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2014-10-13 |