| NPI | 1558942367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019033215) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2022-07-05 |