| NPI | 1912444209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.158544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA11023000) |
| 208D00000X General Practice (Licence: NJ 25MA11023000) | |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2025-05-29 |