| NPI | 1497331847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301509894) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351050340) |
| 207R00000X Internal Medicine (Licence: MI 4301509894) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125078523) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2024-02-28 |