| NPI | 1518753458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070029072) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 23006) |
| Enumeration Date | 2025-04-17 |
| Last Update Date | 2025-08-11 |