| NPI | 1164290607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 122037) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070027759) |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2025-01-10 |