| NPI | 1740840966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036-166350) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 34982) |
| 207Q00000X Family Medicine (Licence: IL 036-166350) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OK 34982) | |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2026-04-02 |