| NPI | 1780094052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 11418) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 305710) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 305710) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 934444003) | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2020-08-31 |