| NPI | 1396353413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.021846) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294711) |
| 225100000X Physical Therapist (Licence: FL PT34228) | |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2020-07-14 |