| NPI | 1972619526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.123240) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34007709) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-08-10 |