| NPI | 1740948090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.026338) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15647-24) |
| Enumeration Date | 2021-12-03 |
| Last Update Date | 2021-12-03 |