| NPI | 1568856177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9613) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.00204643) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DR.0065744) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2021-03-23 |