| NPI | 1326776477 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32121) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 070.026406) |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2025-02-10 |