| NPI | 1053616821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30337) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.016507) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2025-04-28 |