| NPI | 1184883597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10509) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070014828) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2022-01-13 |