| NPI | 1861079022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070026547) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0017471) |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2025-12-18 |