| NPI | 1649268376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 20215) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2023-09-22 |