| NPI | 1235677675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14500-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070021689) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2021-09-02 |