| NPI | 1164605960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28813) |
| Additional Taxonomies | 171W00000X Contractor (Licence: IL 070014792) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2024-06-18 |