| NPI | 1457810012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 38120) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 38120) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2022-07-06 |