| NPI | 1164644266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-133136) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 254524) |
| 207Q00000X Family Medicine (Licence: MD D71983) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2021-03-17 |