| NPI | 1821594466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02006628A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.157211) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2022-05-06 |