| NPI | 1093372609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine Sports Medicine (Licence: IL 036-166091) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: PA OT021756) |
| 207R00000X Internal Medicine (Licence: IL 125.074027) | |
| 207RS0010X Internal Medicine Sports Medicine (Licence: IL 036-166091) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: IL 036-166091) | |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2025-02-18 |