| NPI | 1013763143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.084380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.181021) |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2026-07-15 |