| NPI | 1932635794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 103150) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103150) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.025167) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D011330) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 103250) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-06-29 |