| NPI | 1417305558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: OH 35.147450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.151048) |
| 207Q00000X Family Medicine (Licence: OH 35.147450) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2023-10-20 |