| NPI | 1003871716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11652-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.018066) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2023-08-16 |