NPI | 1184036410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: UT 9033355) |
Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: UT 9033355) |
Enumeration Date | 2014-05-21 |
Last Update Date | 2025-02-11 |