| NPI | 1962624148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: MA 9187) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21886) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-08-20 |