| NPI | 1649764267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036-165889) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301114760) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 57248337) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2023-08-18 |