| NPI | 1891834685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N2592) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-117596) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-07-07 |