| NPI | 1053878488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.027319) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT013433) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2024-01-01 |