| NPI | 1780233171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.024562) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 17058-24) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2026-06-25 |