| NPI | 1396108015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 12013) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9754) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2025-03-23 |