| NPI | 1609636851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.035351) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.035351) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2024-09-05 |