| NPI | 1477141596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.023223) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT298621) |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-04-07 |