| NPI | 1568656445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036123915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2010025569) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125053683) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2022-03-15 |