| NPI | 1861830465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WY 1514) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 29712) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA 60752661) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2021-01-05 |