| NPI | 1932318813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036127345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036127345) |
| 207Q00000X Family Medicine (Licence: IA 37516) | |
| 207Q00000X Family Medicine (Licence: WI 54231) | |
| 207Q00000X Family Medicine (Licence: IA R-7949) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2021-04-12 |