| NPI | 1356966139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 325818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125075464) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2023-09-26 |