| NPI | 1215304480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13220-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070028740) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2024-11-22 |