| NPI | 1720266752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP00002330) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125049655) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2016-07-15 |