| NPI | 1609453950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125081799) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.146550) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2023-07-01 |