NPI | 1649629643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036152244) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125068101) |
Enumeration Date | 2016-06-09 |
Last Update Date | 2022-12-16 |