| NPI | 1770748717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003800A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 36.126288) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125054141) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2020-09-10 |