| NPI | 1447452123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125055484) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301090008) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2008-10-21 |