| NPI | 1891487450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40602) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2024-08-05 |