| NPI | 1538391347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125-057010) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: DE C1-0010514) |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2015-04-08 |