| NPI | 1538867700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRP2693) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH27889) |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2024-09-08 |