| NPI | 1821591397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.023530) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0015362) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2026-01-19 |