| NPI | 1841729449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036.155949) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 22636) |
| 207Q00000X Family Medicine (Licence: MI EMC0000858) | |
| 207Q00000X Family Medicine (Licence: WA MD61088682) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: KY R52811) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2025-01-13 |