| NPI | 1689815193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.095116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.141990) |
| 207Q00000X Family Medicine (Licence: MI 4301095610) | |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2023-11-24 |