| NPI | 1639309180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: AZ 006195) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 006195) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IL BF4649604A392) | |
| Enumeration Date | 2009-07-18 |
| Last Update Date | 2025-08-27 |