| NPI | 1821261892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-128203) |
| Additional Taxonomies | 282E00000X Long Term Care Hospital |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2022-04-14 |