| NPI | 1306329255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16448-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.023928) |
| 225100000X Physical Therapist (Licence: CA 298533) | |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2024-11-25 |