| NPI | 1790332807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022039968) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.024617) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2022-10-06 |