| NPI | 1700317401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0438000474) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401418116) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OR D11891) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2023-10-13 |