| NPI | 1700410909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IL 160007353) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 160.007353) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2024-01-09 |