| NPI | 1952669152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IL 036161110) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R2988) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KY 48295) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2022-10-14 |