| NPI | 1477968105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OK 6581) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IN 12012223A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK LDR140096) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2019-07-09 |