| NPI | 1356652358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 13078680-9925) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DB-2024-0007) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.00204284) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX SWMC 282-X) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2024-01-16 |