| NPI | 1124690441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122400000X Denturist (Licence: WI 1002691) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-09-23 |