| NPI | 1508639295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WA DH61462023) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: OR H8736) |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2025-02-03 |