| NPI | 1235831348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036177812) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125082486) |
| 207Q00000X Family Medicine (Licence: IL 125.082486) | |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2026-06-19 |