| NPI | 1730533811 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036-153000) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ B71711527359902) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2020-11-04 |