| NPI | 1437530094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: NM DH3650) |
| Additional Taxonomies | 174400000X Specialist |
| 225500000X Specialist/Technologist | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2015-06-09 |