| NPI | 1699972893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 67471) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036-116062) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-06-10 |