| NPI | 1750906814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MS OS-6067-24) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MS 4464-24) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 37297) | |
| Enumeration Date | 2020-06-14 |
| Last Update Date | 2024-07-15 |