| NPI | 1730337122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-095821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125053776) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2010-08-11 |