| NPI | 1992444368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125086096) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5151015784) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2025-06-12 |