| NPI | 1518308105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 62950) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62950) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 10983) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MS M12345678) | |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2023-04-20 |