| NPI | 1730618760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 6915) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0442000293) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0442000293) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0442000293) | |
| Enumeration Date | 2017-06-04 |
| Last Update Date | 2021-07-28 |