| NPI | 1841979820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 13438808-9921) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 13438808-9921) |
| 122300000X Dentist (Licence: UT 13438808-8903) | |
| 122300000X Dentist (Licence: NC 14549) | |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2026-05-29 |