NPI | 1497100341 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NM DD5400) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA 17772396) |
Enumeration Date | 2016-04-28 |
Last Update Date | 2021-07-27 |