| NPI | 1184362451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 12905696-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 12905696-9922) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2026-05-08 |