| NPI | 1871596338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NV 9976) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 9976) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IL 036087256) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 036087256) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2010-02-04 |