| NPI | 1235547621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 070020914) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070020914) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2023-08-09 |