| NPI | 1356588990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CA 30965) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: CA 70539) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2017-03-17 |