| NPI | 1164624250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1757) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036123431) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2023-06-15 |