| NPI | 1760739825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-155C) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 9433) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRP1048) | |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2019-04-09 |