| NPI | 1871974709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02005122A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.067572) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2022-07-21 |