| NPI | 1457091142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.173349) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036.173349) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-05-21 |