| NPI | 1629707997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CA HAP938) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CA 26819) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2023-03-23 |