| NPI | 1609196690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1859843) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 269431) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2023-09-08 |