| NPI | 1801258868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.175353) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2025-07-18 |