| NPI | 1790572030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL DRPM2884) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH33314) |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2025-07-02 |