| NPI | 1417440306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 34424) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34424) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2025-02-27 |