| NPI | 1952759755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 036.152726) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125069210) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2021-11-12 |