| NPI | 1114284411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35134072) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036138589) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2020-05-13 |