| NPI | 1114120003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WA HL00007817) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: IL 020.011971) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2007-07-08 |