| NPI | 1508466053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070025391) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05014017A) |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2021-06-02 |