| NPI | 1063062289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.024754) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: IL 070.024754) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-10-01 |