| NPI | 1811488646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036156608) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 036156608) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125072449) | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2025-09-25 |