| NPI | 1538819081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 018002203) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.034147) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 018002203) | |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2023-06-10 |