| NPI | 1750890877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 136.000224) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 136.000224) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2023-03-27 |