| NPI | 1558772293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: ID DH2444) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CO 000906568) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2025-11-03 |