| NPI | 1629224183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 51723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036128750) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CO 51723) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2012-10-09 |