| NPI | 1508212770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 10490) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 12149) |
| 1223G0001X Dentist, General Practice (Licence: KY 10206) | |
| 1223G0001X Dentist, General Practice (Licence: SC 9287) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DB-2023-0206) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2023-07-24 |