| NPI | 1073453072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 42383) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: TX 42383) |
| 122300000X Dentist (Licence: TX 42383) | |
| Enumeration Date | 2026-03-30 |
| Last Update Date | 2026-07-16 |