| NPI | 1508257833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 314992) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.073453) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2023-10-25 |