| NPI | 1154848034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070023183) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14709) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2019-06-25 |