NPI | 1194217166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MI 2901602634) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019031843) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901602634) | |
Enumeration Date | 2018-06-05 |
Last Update Date | 2025-09-02 |