| NPI | 1225722580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 13414829-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 134148299921) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 134148299921) | |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2023-08-10 |