| NPI | 1730310673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-098932) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.056317) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2021-09-10 |