| NPI | 1659720779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S0812) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.069152) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2019-07-18 |