| NPI | 1326552712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2017031930) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 70.023464) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2025-06-04 |