| NPI | 1588012421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: KS 11998) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CO 002024309) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2016-06-01 |