| NPI | 1194420422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 8214221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 336133147) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11023127A) | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-09-02 |