| NPI | 1083173322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 7738316-1204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 036.164367) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.074603) | |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2024-05-17 |