| NPI | 1194091991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.136528) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.062127) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125062127) | |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2024-04-04 |