| NPI | 1386881688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125.053832) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01069154A) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2023-06-15 |