| NPI | 1548300395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036137322) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME 99969) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IN 01061202A) | |
| 208D00000X General Practice (Licence: FL me99969) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2021-11-23 |