| NPI | 1578718029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CA 20884) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CA 111) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2008-11-25 |