| NPI | 1912391707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: OR H6818) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: OR H6818) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2015-04-08 |