| NPI | 1902376155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-025214) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS 6594) |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2022-08-19 |