| NPI | 1629461868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024201) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.022242) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2023-01-19 |