| NPI | 1184177198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 35096) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV LL-426-16) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV LL-426-16) | |
| 122300000X Dentist (Licence: NV LL-426-16) | |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2024-02-28 |