NPI | 1588356133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WI 1003590-16) |
Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: IL 020.015636) |
Enumeration Date | 2023-05-23 |
Last Update Date | 2023-05-23 |