| NPI | 1417836990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.029291) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 17290-24) |
| Enumeration Date | 2025-08-29 |
| Last Update Date | 2025-08-29 |