| NPI | 1558910067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.026834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14828-24) |
| 225100000X Physical Therapist (Licence: SC PT.9861) | |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2025-06-03 |