| NPI | 1831624618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D010666) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0442000292) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0442000292) | |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2023-06-29 |