| NPI | 1376648212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 377963-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036119791) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2021-09-30 |