| NPI | 1730506601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 036149973) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 10766520-1204) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2019-10-04 |