| NPI | 1760639827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 20120269202) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125054616) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2012-12-05 |