| NPI | 1528876778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2024047307) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.029250) |
| Enumeration Date | 2024-12-19 |
| Last Update Date | 2025-09-13 |