| NPI | 1902432404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WA DH60749768) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: ID DH-1951-ER) |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2024-04-18 |