| NPI | 1750673562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA ds038714) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038714) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA ds038714) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VT 016.0116639) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DE G3-0000381) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2024-09-11 |