| NPI | 1518388685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213659) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.019651) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2025-12-11 |