| NPI | 1003430208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U8752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.076883) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2025-07-01 |