| NPI | 1417418203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 600233015) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: IL pending) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2026-10-13 |