| NPI | 1023389327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q3265) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036132809) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2021-01-06 |