| NPI | 1215511027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036166827) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 036166827) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125077693) | |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2024-06-12 |