| NPI | 1952693798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 66839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036134321) |
| 207Q00000X Family Medicine (Licence: IN 01072920A) | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2023-02-03 |