| NPI | 1548780026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A17533) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A17533) |
| 208D00000X General Practice (Licence: IL 036179516) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2026-07-12 |