| NPI | 1902079981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070013727) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: IL 060010072) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2024-08-01 |