| NPI | 1023562980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070026575) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI CP032210T) |
| 225100000X Physical Therapist (Licence: KY CP000939T) | |
| 225100000X Physical Therapist (Licence: MO 2016027711) | |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2025-12-24 |