| 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 |