| NPI | 1750619243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036124986) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 02003798A) |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2012-01-23 |