| NPI | 1861247017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070028189) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 26241) |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-10-25 |