| NPI | 1245595040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: LA DO.000439) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA DO.000439) |
| 207Q00000X Family Medicine (Licence: IL 036.135934) | |
| Enumeration Date | 2012-07-08 |
| Last Update Date | 2020-02-19 |