| NPI | 1639552201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10636800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125067490) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2019-10-01 |