| NPI | 1275232068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 138646) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070027235) |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2026-08-04 |