| NPI | 1184155020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T3712) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 7133620) |
| 207Q00000X Family Medicine (Licence: IN 01084534A) | |
| 207Q00000X Family Medicine (Licence: IL 036.153308) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-01-31 |