| NPI | 1598179491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T1242) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036143771) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125-065418) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2021-12-27 |