| NPI | 1518690387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2026038840) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-027274) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2026-08-13 |