| NPI | 1164760898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-011660) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070019693) |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2022-07-26 |