| NPI | 1568957090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 019031963) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013041A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2019-07-10 |