| NPI | 1205667086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: TX 136297) |
| Enumeration Date | 2024-08-12 |
| Last Update Date | 2024-08-12 |