| NPI | 1730560996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: NJ 22HI00706700) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: NV 101140) |
| 124Q00000X Dental Hygienist (Licence: NY 023681-1) | |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2015-06-14 |