| NPI | 1821286121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125.060780) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 02003286A) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2022-01-21 |