| 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 |