| NPI | 1376181867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37699) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 37699) | |
| Enumeration Date | 2019-12-15 |
| Last Update Date | 2023-06-28 |