| NPI | 1780683953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01086883A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036074987) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2021-12-23 |