| NPI | 1184612178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101267175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036112944) |
| 207Q00000X Family Medicine (Licence: TX N2112) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2023-03-09 |