| NPI | 1245755958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME161126) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036153273) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.071569) | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2023-06-12 |