| NPI | 1265010847 |
|---|---|
| Former Name | OMAR GUILLERMO GARCIA CHACON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 04745) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2022-07-22 |