| NPI | 1710027412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19-018689) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901017149) |
| 122300000X Dentist (Licence: MA 21475) | |
| 122300000X Dentist (Licence: MO 2004032394) | |
| 122300000X Dentist (Licence: NY 051850-1) | |
| 122300000X Dentist (Licence: CA 52230) | |
| 122300000X Dentist (Licence: WI 4884-015) | |
| 122300000X Dentist (Licence: CT 009297) | |
| 122300000X Dentist (Licence: NJ 22DI02132500) | |
| 122300000X Dentist (Licence: NM DD2474) | |
| 122300000X Dentist (Licence: AZ D07630) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2013-05-06 |