| NPI | 1952861486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036161688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036161688) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036161688) | |
| 207P00000X Emergency Medicine (Licence: IL 036161688) | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2026-01-22 |