| NPI | 1538726567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 126800000X Dental Assistant (Licence: OR 000525) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: WA D160718103) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2020-10-12 |