| NPI | 1124722384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021.003541) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: IL 019.034314) | |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2026-07-07 |