| NPI | 1407591076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.177566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.017906) |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2026-02-06 |