| NPI | 1023483864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-021942) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1324550) |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2023-04-19 |