| NPI | 1750721254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10047018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.142988) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2022-01-26 |