| NPI | 1467059113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019749) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.025147) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2021-09-28 |