| NPI | 1609443696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V4421) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.077904) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-11-21 |