| NPI | 1023515921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.156836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01083136A) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2021-07-14 |