| NPI | 1396421558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1378054) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.027559) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2023-06-25 |