| NPI | 1477089308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0442000317) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0442000317) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-08-16 |