| NPI | 1063153005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 125.080462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MTL500002788) |
| 208D00000X General Practice (Licence: IL 125.080462) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-06-19 |