| NPI | 1417659160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.177031) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036.177031) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208D00000X General Practice (Licence: CA A197207) | |
| 208D00000X General Practice (Licence: FL ME1777341) | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-05-26 |