| NPI | 1225680788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-011160) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070019825) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2019-07-15 |