| NPI | 1245450832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: ME MD20416) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: IL 036121017) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2014-12-29 |