| NPI | 1235790296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CT 8755) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: NY 030035-1) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2023-11-27 |