| NPI | 1891478244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 018002280) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 018002280) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2024-07-18 |