| NPI | 1194217166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2951000970) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031843) |
| 122300000X Dentist (Licence: MI 2951000970) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2024-07-06 |