| NPI | 1780235093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.029254) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14854-24) |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2025-07-30 |