| NPI | 1730755232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 81440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125078715) |
| 207Q00000X Family Medicine (Licence: WI 8946) | |
| 207Q00000X Family Medicine (Licence: WI 81440) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2024-05-24 |