| NPI | 1093182271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 019.030194) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN R731) |
| 122300000X Dentist (Licence: IL 019.030194) | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2024-09-13 |