NPI | 1043210065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 6467) |
Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CO 6467) |
Enumeration Date | 2005-08-01 |
Last Update Date | 2019-07-30 |