| NPI | 1396970653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 18270) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY P64379) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P64379) | |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2018-03-27 |