| NPI | 1639674245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036175980) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.147098) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-09-23 |