| NPI | 1366528242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F7136) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036069962) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2018-03-17 |