| NPI | 1003075383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083S0010X Preventive Medicine, Sports Medicine (Licence: MN 261QM1300X) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.053428) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2014-01-30 |