| NPI | 1407295371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 311846-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036139887) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2025-03-24 |