| NPI | 1225402431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: ID DH-3061) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WA IL 60428729) |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2015-11-25 |