| NPI | 1407054224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 8385) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 8385) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0442000070) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2023-07-04 |