| NPI | 1275135691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018210) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.025159) |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2024-08-29 |