| NPI | 1023645553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070024307) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070.024307) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2020-11-13 |