| NPI | 1992875280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN8437) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL DN8437) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2019-02-27 |