| NPI | 1487049219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8689) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CO 8689) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2019-10-02 |