| NPI | 1023994738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305217357) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070029329) |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-12-17 |