| NPI | 1730562422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101025744) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.066293) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2021-03-31 |