| NPI | 1063637544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-133790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57012414) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2023-08-04 |