| NPI | 1952963878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A17753) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036162111) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036162111) | |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2026-02-09 |