| NPI | 1609456771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019033126) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2022-07-18 |