| NPI | 1326580549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070039759) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 10412) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2026-04-21 |