| NPI | 1639656994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-024852) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-30078) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2019-12-13 |