| NPI | 1407153612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122400000X Denturist (Licence: OR DT-DO-10189132) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: OR H5633) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2019-12-20 |