| NPI | 1750311999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: WI 68469) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036096721) |
| 207P00000X Emergency Medicine (Licence: IL 036096721) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036-096721) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 360967212) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2021-12-20 |