| NPI | 1568718476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01075184A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125060949) |
| Enumeration Date | 2012-07-29 |
| Last Update Date | 2021-02-17 |