| NPI | 1245761899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NV DO3234) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125073409) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 036155443) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2022-11-15 |