| NPI | 1720009590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX L3765) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L3765) |
| 207N00000X Dermatology (Licence: TX L3765) | |
| 207Q00000X Family Medicine (Licence: IL 036.162935) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-09-13 |