| NPI | 1164099966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036.176366) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2025-08-13 |