| NPI | 1558678813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021002624) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28267) |
| 122300000X Dentist (Licence: MI 2901020780) | |
| 122300000X Dentist (Licence: IN 12012265A) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: IL 137000907) | |
| 1223P0300X Dentist, Periodontics (Licence: TX 28267) | |
| 1223P0300X Dentist, Periodontics (Licence: WV 4134) | |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2018-05-07 |