| NPI | 1356401343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036169584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G1491) |
| 207Q00000X Family Medicine (Licence: KS 05-37032) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2024-04-23 |