| NPI | 1841926763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38970) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00205275) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 38970) | |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2023-08-26 |