| NPI | 1700285137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018005) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-021112) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2024-09-29 |