| NPI | 1881139681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1377887) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070021908) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2025-10-13 |