| NPI | 1912700766 |
|---|---|
| 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: FL DR139978) |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-03-29 |