| NPI | 1548426158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101027951) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036126596) |
| 207Q00000X Family Medicine (Licence: IL 036-126596) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101027951) | |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2024-08-06 |