| NPI | 1912677220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: MD 7293) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: CO DH.002025759) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2021-09-17 |