| NPI | 1124495148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13296) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070021746) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2024-07-23 |