NPI | 1497840375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 21267) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D6692) |
1223G0001X Dentist, General Practice (Licence: MT 21627) | |
332B00000X Durable Medical Equipment & Medical Supplies (Licence: MT 21627) | |
Enumeration Date | 2006-10-04 |
Last Update Date | 2024-11-12 |