| NPI | 1699090340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036.134581) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 20176100601) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 67840) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.121333) | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2021-11-30 |