| NPI | 1619090362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901018730) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901018730) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901018730) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301088665) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2009-10-29 |