| NPI | 1609854942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD472928) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036123475) |
| 207Q00000X Family Medicine (Licence: OH 35. 077217) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2021-06-02 |