| NPI | 1427372879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 2021-00547) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2021-00547) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2021-07-07 |