| NPI | 1578095295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2021031388) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036.160100) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2022-08-10 |