NPI | 1568547453 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NC 9069) |
Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC 9069) |
Enumeration Date | 2006-10-26 |
Last Update Date | 2019-02-05 |