| NPI | 1922774819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-028922) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1335739) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2025-03-04 |