| NPI | 1497571061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: TX 136978) |
| Enumeration Date | 2024-11-28 |
| Last Update Date | 2025-07-20 |