| NPI | 1053706309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A16396) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125066917) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: IL 036.146095) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2021-11-05 |