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 |