| NPI | 1255674263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036151161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 49191) |
| 207Q00000X Family Medicine (Licence: OH 35.140908) | |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2022-08-11 |