| NPI | 1306281241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9364) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9364) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2022-10-13 |