| NPI | 1497324719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38002) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7756) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2023-07-31 |