| NPI | 1992904221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.125928) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 39177) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2023-08-08 |