| NPI | 1972120913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 84840) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019032695) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2026-05-11 |