| NPI | 1497491500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2022021002) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019035965) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2025-06-26 |