| NPI | 1588072987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 32883) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32883) |
| 122300000X Dentist (Licence: OR D10343) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2023-07-27 |