| NPI | 1477442804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: IL 070.029136) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070029136) |
| Enumeration Date | 2025-07-01 |
| Last Update Date | 2025-10-30 |