| NPI | 1710339791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12902) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.022416) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2022-07-21 |