| NPI | 1649649252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015512) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070021477) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2022-07-25 |