| NPI | 1518355973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070024749) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21474) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2023-10-12 |