| NPI | 1326690751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1337891) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: IL 070024652) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2022-09-15 |