| NPI | 1730490111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125057767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01096764A) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2025-07-23 |