| NPI | 1932535317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: GA 14442) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070020149) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2021-07-14 |