| NPI | 1073994398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.147690) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125067413) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2023-11-14 |