| NPI | 1588865943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 23464) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX A000986496) |
| 1223P0300X Dentist, Periodontics (Licence: NV S4-97C) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2018-04-30 |