| NPI | 1396437166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WA IL61596600) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH29766) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2025-02-07 |