| NPI | 1871516724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 1941) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: SC 1941) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-06-29 |