| NPI | 1902419070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA DDS-09820) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 09820) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: IA 09820) | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2022-08-17 |