| NPI | 1750739066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CO 000906530) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WY 989) |
| 124Q00000X Dental Hygienist (Licence: CO 02783444) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2016-05-26 |