| NPI | 1396406476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013892A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019034052) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-12-31 |
| Last Update Date | 2025-03-17 |