| NPI | 1740178169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2026020978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-029196) |
| Enumeration Date | 2025-06-25 |
| Last Update Date | 2026-06-12 |