NPI | 1740939628 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036.174382) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A190873) |
Enumeration Date | 2022-03-20 |
Last Update Date | 2025-06-28 |