| NPI | 1356604508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 60670) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D13139) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2017-05-25 |