| NPI | 1811561277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036175984) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: SC LL83572) | |
| 207Q00000X Family Medicine (Licence: OH 34.017266) | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2025-11-26 |