| NPI | 1194987461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2010003855) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.134874) |
| 207Q00000X Family Medicine (Licence: MO 2010003855) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036.134874) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2024-04-10 |