| NPI | 1659509578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070017530) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 019564) |
| 225100000X Physical Therapist (Licence: TX 1311723) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2023-06-17 |