| NPI | 1831400787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20058) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028837) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2022-06-21 |