| NPI | 1265511422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22738) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: TX 22738) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 22738) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2014-06-12 |