| NPI | 1518350248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 33406) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM TD-00-72) |
| 122300000X Dentist (Licence: NM DD4478) | |
| 122300000X Dentist (Licence: TX 33406) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2023-09-25 |