| NPI | 1497995799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: UT 7024861-9920) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CA 24320) |
| 124Q00000X Dental Hygienist (Licence: NV 101503) | |
| 124Q00000X Dental Hygienist (Licence: AZ 6457) | |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2009-02-25 |