| NPI | 1568752814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9664) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD188695) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2025-09-16 |