| NPI | 1013536267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY TP636) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036.162211) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2023-07-03 |