| NPI | 1851486575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 103386) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036118172) |
| 207Q00000X Family Medicine (Licence: IL 036118172) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2012-08-10 |