| NPI | 1760969422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125K00000X Advanced Practice Dental Therapist (Licence: AK 18-147-DHAT) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2022-09-07 |