| NPI | 1497374417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.163582) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.163582) |
| 208000000X Pediatrics (Licence: IL 036.163582) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036163582) | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2025-09-17 |