| NPI | 1508313651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070022274) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 0800727) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2023-10-17 |