| NPI | 1841548716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.028715) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IL 160.006055) |
| Enumeration Date | 2012-08-26 |
| Last Update Date | 2025-08-25 |