| NPI | 1932782703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019034044) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019-034044) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019.034044) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2023-09-26 |