| NPI | 1891145652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036146684) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10056695) |
| 207Q00000X Family Medicine (Licence: OK 32358) | |
| 207Q00000X Family Medicine (Licence: TX R8121) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2021-04-30 |