| NPI | 1427519875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036166145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151015355) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2026-04-07 |