| NPI | 1013373323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.021481) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2022-04-06 |