| NPI | 1750067468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH30082) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-06-26 |