| NPI | 1356933840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 13633560-9926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV LL-550-21) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-06 |
| Last Update Date | 2025-06-13 |