| NPI | 1073792396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.018733) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2008001020) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2024-10-02 |