| NPI | 1689974156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: OR H5253) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WA DH00007943) |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2015-08-12 |