| NPI | 1174144323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.075828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.075828) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2021-06-10 |