| NPI | 1407220940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070021914) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2022033276) |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2022-10-27 |