| NPI | 1144775149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 136000247) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL13013) |
| 1223P0300X Dentist, Periodontics (Licence: MA DL13013) | |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2024-04-01 |