| NPI | 1689611865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-094847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 60-274126) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-08-17 |