| NPI | 1255710810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 2019-02699) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2019-02699) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2022-04-01 |