| NPI | 1043730344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD495229) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036153421) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: IL 036153421) | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2026-06-17 |