| NPI | 1538300561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036169796) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IN 02004856A) |
| Enumeration Date | 2009-03-21 |
| Last Update Date | 2025-09-19 |