| NPI | 1811321995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070020171) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT 60531867) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2023-12-20 |