| NPI | 1821594565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036-162214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 238740) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2024-02-01 |