| NPI | 1306125521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R5554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036134399) |
| 207Q00000X Family Medicine (Licence: TX R5554) | |
| 207Q00000X Family Medicine (Licence: IL 125.060613) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2021-08-06 |