| NPI | 1962013136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 118904339921) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2023-08-03 |