| NPI | 1447706049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 100401) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401418390) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN26788) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2024-06-17 |