| NPI | 1356560403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036116963) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036116963) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2011022924) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2015-09-11 |