| NPI | 1306570106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23389) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070026719) |
| 225100000X Physical Therapist (Licence: AZ LPT-33248) | |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2024-09-11 |