| NPI | 1386133296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WI 83583-20) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2024-05-02 |