| NPI | 1053716324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: NC 7890) |
| Additional Taxonomies | 247000000X Technician, Health Information |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2014-10-29 |