| NPI | 1346787223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: SC 10319) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: GA DH012785) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2017-01-30 |