| NPI | 1245366194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN20406) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 122300000X Dentist (Licence: FL DN20406) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2019-04-30 |