| NPI | 1447631445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY None) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030361) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2019-03-17 |