| NPI | 1467992636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019022728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.070587) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2024-06-25 |