| NPI | 1447305958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: MA DH11561) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MA 11561) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2011-12-21 |