| NPI | 1336844877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.034348) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2024-05-28 |