| NPI | 1699061457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01074246A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.059735) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2021-04-30 |