| NPI | 1407479116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 125077324) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 125077324) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125077324) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046712) | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2024-06-20 |