| NPI | 1932790482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15721-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-025589) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2022-11-02 |