| NPI | 1942704507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 85626-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-156701) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-05-08 |