| NPI | 1235458514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2010016173) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MO 2010016173) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2025-11-10 |