| NPI | 1740283803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-083482) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02008814A) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2025-12-15 |