NPI | 1699355511 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036176613) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036176613) |
207QS0010X Family Medicine, Sports Medicine (Licence: IN 02007938A) | |
Enumeration Date | 2021-04-13 |
Last Update Date | 2025-09-10 |