| NPI | 1184979056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020209) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070013913) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2025-06-19 |