| NPI | 1588123624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 036.169362) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.076166) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.033275) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-06-10 |