| NPI | 1922687326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 8144) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 39755) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-11-11 |