| NPI | 1508927757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.246804) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-017132) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2018-06-29 |