| NPI | 1942868633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036159971) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 036159971) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125074314) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2022-07-21 |