| NPI | 1467552992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-072946) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2026-08-19 |