| 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 |