| NPI | 1740962828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-028648) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1379734) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2025-03-14 |