| NPI | 1245493089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME113046) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-055283) |
| 207QS0010X Family Medicine Sports Medicine (Licence: FL ME113046) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2023-06-06 |