| NPI | 1831397876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35132601) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125051088) |
| 207Q00000X Family Medicine (Licence: IL 036123137) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2018-01-18 |