| NPI | 1891499513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.084684) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2024-09-04 |