| NPI | 1235659483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.141516) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125071416) |
| 207Q00000X Family Medicine (Licence: IL 036152321) | |
| 207Q00000X Family Medicine (Licence: MO 2019037672) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-11-29 |