| NPI | 1659850816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-023478) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14069-24) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2022-09-27 |