NPI | 1982637450 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036109178) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036109178) |
Enumeration Date | 2006-07-08 |
Last Update Date | 2021-03-03 |