| NPI | 1457995615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036164814) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.031379) |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2023-08-08 |