| NPI | 1083270169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 327935) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.075522) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2025-06-09 |