| NPI | 1508215138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: OR H5977) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CA 25644) |
| Enumeration Date | 2016-06-04 |
| Last Update Date | 2016-06-04 |