| NPI | 1558462531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036093294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036093294) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036.093294) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IL 036.093294) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2013-09-19 |