| NPI | 1932580230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036159358) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301108007) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301108007) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-08-05 |