| NPI | 1366891210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: NE 2268) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125.068702) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2020-10-21 |