| NPI | 1487293015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37705) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070024905) |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2022-12-28 |