| NPI | 1518546472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 100254) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033095) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2023-06-02 |