| NPI | 1962586149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-113672) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 253937) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-07-06 |