| NPI | 1417457524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 7821520-9925) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D-5568-OS) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30526) | |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2023-12-08 |