| NPI | 1548399496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-089419) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP1527) |
| 207Q00000X Family Medicine (Licence: CA 20A6719) | |
| 207Q00000X Family Medicine (Licence: MA 78031) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036-089419) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WA OP1527) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A6719) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MA 78031) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-08 |