| NPI | 1790527844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.084012) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125084012) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-08-12 |