| NPI | 1295419497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.028378) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16291-24) |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2024-07-02 |