| NPI | 1922489327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IL 036.157985) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 68051) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2025-07-14 |