| NPI | 1861625444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q5496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036125697) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2024-09-19 |