| NPI | 1588044358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R8235) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125067362) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2022-08-11 |