| NPI | 1598292799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036151131) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 0361117063) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2020-10-22 |