NPI | 1316328776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 291583-1) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125067475) |
Enumeration Date | 2015-06-11 |
Last Update Date | 2021-12-10 |