| NPI | 1255541678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036123324) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-06-16 |