| NPI | 1851553242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MN D13297) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IA 30262) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MN NOT YET OBTAINED) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2023-05-05 |