| NPI | 1366846503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019029877) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: IL 021.002875) |
| 1223E0200X Dentist Endodontics (Licence: IL 019029877) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30482) | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2020-10-26 |