| NPI | 1205330404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036155609) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 86828) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX T2217) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS16692) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A18142) | |
| 207R00000X Internal Medicine (Licence: MS 27997) | |
| 207R00000X Internal Medicine (Licence: IL 036.155609) | |
| 207R00000X Internal Medicine (Licence: IL 336.119909) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2024-05-24 |