NPI | 1962903112 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE61485147) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031837) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-02-23 |
Last Update Date | 2024-03-11 |