| NPI | 1982048070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 63016) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 36143044) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2022-01-24 |