NPI | 1689175697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 33973) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 33973) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-02-24 |
Last Update Date | 2022-11-07 |