| NPI | 1801176136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: ID N-9870) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID N-9870) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: CO 00205167) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30418) | |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2022-08-17 |