| NPI | 1073006805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036157485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125072815) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125072815) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2022-11-14 |