| NPI | 1417522418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070028864) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: WA PT61564100) | |
| 225100000X Physical Therapist (Licence: TX 1345751) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2025-01-15 |