| NPI | 1528523826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0016715) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070024105) |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2022-05-03 |