| NPI | 1538101571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L3674) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L3674) |
| 207Q00000X Family Medicine (Licence: IL 036-114577) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2022-07-01 |