| NPI | 1902424658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 208100000X) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 157332) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL 157132) | |
| Enumeration Date | 2020-07-09 |
| Last Update Date | 2024-08-20 |