NPI | 1609561539 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41578) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
122300000X Dentist (Licence: TX 41578) | |
Enumeration Date | 2023-04-06 |
Last Update Date | 2025-07-08 |