| NPI | 1881836542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1859248) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL ME 128500) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS041314) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS041314) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD462147) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2021-11-18 |