NPI | 1174658546 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 4479) |
Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AL 4479) |
Enumeration Date | 2007-02-23 |
Last Update Date | 2019-07-10 |