| NPI | 1740711050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.153777) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11019411A) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2021-02-26 |