| NPI | 1316495856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070016110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31103) |
| 225100000X Physical Therapist (Licence: CA 43200) | |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2022-11-07 |