| NPI | 1679283824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.027915) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT302754) |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2023-12-30 |