| NPI | 1750736922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS041021) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401416865) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0442000282) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS041021) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0442000282) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2024-02-19 |