| NPI | 1104412139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30487) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-025543) |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2025-08-04 |