| NPI | 1881188316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A173784) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.072938) |
| 207Q00000X Family Medicine (Licence: NY 311786) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2021-07-24 |