| NPI | 1659866077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031695) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2018-06-27 |