| NPI | 1306376595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036167074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 303619) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2023-09-26 |