| NPI | 1427773373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: DC HYG2001128) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH21761) |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2022-10-04 |