| NPI | 1639668668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 126800000X Dental Assistant (Licence: CA RDA85936) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: CA OA49112) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-05-04 |