| NPI | 1053892752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070024236) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P18312) |
| 225100000X Physical Therapist (Licence: WY PT-1846) | |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2023-02-12 |