| NPI | 1790422053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036174305) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT021596) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2025-05-21 |