| NPI | 1487965828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA DDS60860) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DR 60288665) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA DR60288665) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 12011690A) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2023-05-10 |