| NPI | 1003159021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101267865) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036.158986) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 73720) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.128356) | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2023-11-09 |