| NPI | 1477344745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-08112) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-029083) |
| 225100000X Physical Therapist (Licence: MO 2026008840) | |
| Enumeration Date | 2025-05-15 |
| Last Update Date | 2026-02-25 |