| NPI | 1922078393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN 8431) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN012683) |
| 1223G0001X Dentist, General Practice (Licence: TN DS0000008431) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2020-07-21 |