| NPI | 1942533302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: WA DH60104733) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: WA D160048934) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2009-09-16 |