| NPI | 1528078714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P5004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036057595) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2014-05-19 |