| NPI | 1285085001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214490) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070022162) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2021-10-12 |