| NPI | 1316784028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125K00000X Advanced Practice Dental Therapist (Licence: AK 24-187-DHAT) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: AK 24-187-DHAT) |
| Enumeration Date | 2024-07-10 |
| Last Update Date | 2024-09-17 |