| NPI | 1164061388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070029286) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2305213280) |
| 225100000X Physical Therapist (Licence: MA PTL80993) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC P20965) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: DC CP028099T) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MD CP025408T) | |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2026-05-27 |