| NPI | 1528086741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN30211) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN013297) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 122300000X Dentist (Licence: SC 4035) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-08-11 |