| NPI | 1346892734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN 12976) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 11076) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2026-02-23 |