| NPI | 1326570516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12005) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031209) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2022-09-06 |