| NPI | 1750998704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.00912) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: IL 096004052) |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2024-03-26 |