| 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 |