| NPI | 1295859957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 11529) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2013-10-31 |