| NPI | 1437608569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036149314) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL L.4426) |
| Enumeration Date | 2016-09-30 |
| Last Update Date | 2021-08-13 |