| NPI | 1558149971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.027729) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070027729) |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2024-08-15 |