NPI | 1649534447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036139014) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036139014) |
Enumeration Date | 2012-06-27 |
Last Update Date | 2021-04-07 |