| NPI | 1669827184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 36948) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 36948) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX T6489) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 12196) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 2022-00732) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX T6489) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NC 12196) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NC 2022-00732) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2022-08-29 |