| NPI | 1427639038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 1002773-15) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 1002773) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30614) | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2026-06-20 |