| NPI | 1013390806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.132905) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125067834) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2018-10-30 |