| NPI | 1518488055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021.003064) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: IL 021003064) |
| 1223G0001X Dentist, General Practice (Licence: IL 019031169) | |
| 1223G0001X Dentist, General Practice (Licence: OH 30.025476) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2020-08-28 |