| NPI | 1467909333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: OR H4571) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WA HL60004995) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-09-07 |