| NPI | 1649473638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 32774) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME114705) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2024-01-31 |