| NPI | 1396710919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 24765) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2009014090) |
| 207Q00000X Family Medicine (Licence: IL 036.124133) | |
| 207Q00000X Family Medicine (Licence: FL ME91718) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2020-10-08 |