| NPI | 1295188258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070023663) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT31363) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2019-04-23 |