| NPI | 1003995085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 19705) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2022-03-28 |