| NPI | 1033810460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 41085) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223G0001X Dentist, General Practice (Licence: NC 13337) | |
| 1223G0001X Dentist, General Practice (Licence: TX 41085) | |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2024-10-30 |