| NPI | 1528215431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401417924) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID d4377-OS) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: ID d4377-OS) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2023-05-30 |