| NPI | 1720541527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036165768) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2021030583) |
| 207Q00000X Family Medicine (Licence: IL 036165768) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2024-06-26 |