| NPI | 1538746177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036167382) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 328539-01) |
| 207Q00000X Family Medicine (Licence: IL 036.167382) | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-03-13 |