| NPI | 1750776175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: IL 036-158102) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036-158102) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.246984) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.067990) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2021-08-26 |