| NPI | 1003838525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 0012137) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: FL DN12137) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-09-11 |