| NPI | 1629089958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U2191) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036078648) |
| 202K00000X (Licence: TX U2191) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2024-09-19 |