| NPI | 1396958120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: VA 0402203148) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: DC HYG1000420) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |