| NPI | 1073239901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23722) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070027121) |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2025-02-28 |