| NPI | 1619230794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2012016755) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036-141524) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2020-06-30 |