| NPI | 1619121324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME107516) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125053263) |
| 208D00000X General Practice (Licence: PR 017019) | |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2016-12-07 |