| NPI | 1598100372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9346) |
| Additional Taxonomies | 174400000X Specialist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2023-01-18 |