| NPI | 1396371530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 37911) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1002388-15) |
| 122300000X Dentist (Licence: TX 37911) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2025-06-26 |