| NPI | 1023132859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FABIAN DAVID LATOCHA Owner 847-623-2830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IL 019.022774) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2008-04-09 |