| NPI | 1508366717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30652) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019032088) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2023-06-22 |