| NPI | 1821235698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1096) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125053473) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2018-09-19 |