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 |