| NPI | 1487186078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W7181) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036160699) |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2026-08-01 |