| NPI | 1033288063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN13346) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL 13346) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2019-02-12 |