| NPI | 1710472964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125.073359) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 125.073359) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-07-25 |