| NPI | 1417124769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036123684) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003580A) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2021-04-29 |