| NPI | 1447708581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: OR H3572) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WA DH 00005568) |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2016-09-19 |