| NPI | 1255837167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 16858) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019032035) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2023-06-11 |