| NPI | 1669991808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15897) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.023302) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2022-12-30 |