| NPI | 1457795569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 70125) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036144493) |
| 207Q00000X Family Medicine (Licence: TX Q6620) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2021-01-27 |