| NPI | 1053818997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 338796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036157955) |
| Enumeration Date | 2018-04-08 |
| Last Update Date | 2025-11-12 |