| NPI | 1821283193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2009020188) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 125-057368) |
| 207P00000X Emergency Medicine (Licence: MO 2009020188) | |
| 207Q00000X Family Medicine (Licence: MO 2009020188) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2024-07-17 |