| NPI | 1265847941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036.143805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036143805) |
| 207Q00000X Family Medicine (Licence: IL 125.065628) | |
| Enumeration Date | 2014-06-22 |
| Last Update Date | 2021-11-18 |