| NPI | 1407503279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WI 7001565-16) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: IL 020.016942) |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2025-07-17 |