| NPI | 1306838255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: IL 036151881) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 52444) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2023-11-08 |