| NPI | 1295475408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.034647) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA DR61426866) | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2023-10-19 |