| NPI | 1174866859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 285418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036140874) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2020-03-17 |