| NPI | 1982768123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: CO 903153) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL DH10014) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2015-03-06 |