| NPI | 1851952279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036157851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 315960) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2025-01-02 |