| NPI | 1245617828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 306622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036142393) |
| Enumeration Date | 2015-05-02 |
| Last Update Date | 2024-10-24 |