| NPI | 1982045944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 33706) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009931) |
| 122300000X Dentist (Licence: CA 100932) | |
| 122300000X Dentist (Licence: GA DN015175) | |
| 122300000X Dentist (Licence: TX 33706) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 100932) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: GA DN015175) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2018-07-10 |