| NPI | 1497365746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2020016122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070027998) |
| Enumeration Date | 2020-08-02 |
| Last Update Date | 2023-12-27 |