| NPI | 1730633025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IL 019030662) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030662) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2025-08-19 |