| NPI | 1750825717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070022399) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IL 070022399) |
| Enumeration Date | 2016-12-10 |
| Last Update Date | 2022-02-22 |