| NPI | 1831174598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036105337) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA MD48064) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2021-03-19 |