| NPI | 1598011298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501019916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-019189) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2026-09-14 |