| NPI | 1982071478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901602012) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MN R639) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13963) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 72000) | |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2024-05-29 |