| NPI | 1699975185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01075252A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036.125263) |
| 207Q00000X Family Medicine (Licence: PA MT189963) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2023-11-27 |