| NPI | 1336726801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX V7481) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125079977) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-08-14 |