| NPI | 1801389184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 41272) |
| 122300000X Dentist (Licence: CA 103637) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2025-03-23 |