| NPI | 1144468984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R1730) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME106066) |
| 207Q00000X Family Medicine (Licence: IL 125-052-719) | |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2024-04-02 |