| NPI | 1265668750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.133962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 9999) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2022-07-21 |