NPI | 1558538637 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN13764) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN13764) |
332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL DN13764) | |
Enumeration Date | 2008-05-08 |
Last Update Date | 2017-03-17 |