| NPI | 1629538095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 196997) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125074291) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-11-22 |