| NPI | 1184063331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02004819A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.063436) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2021-02-03 |