| NPI | 1487877999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.089455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 36117724) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2023-01-06 |