| NPI | 1487396453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-029686) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216288) |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2025-12-16 |