| NPI | 1902563802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 300374) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070021917) |
| Enumeration Date | 2021-11-26 |
| Last Update Date | 2023-09-29 |