| NPI | 1649629643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-152244) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125068101) |
| 207QS0010X Family Medicine Sports Medicine (Licence: IL 036152244) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2025-04-07 |