| NPI | 1346730702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 39262) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 16781) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 061019) | |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2024-06-18 |