| NPI | 1548773385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WA DH6068736) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WA IL60704501) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2021-01-13 |