| NPI | 1942755913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070025246) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2016032992) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2020-08-13 |