NPI | 1306092663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 11959048) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 57690) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 57690) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2008-08-18 |
Last Update Date | 2023-01-16 |