| NPI | 1053847186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036151529) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125-070084) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2021-03-15 |