| NPI | 1952735227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015103) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070020086) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2024-01-02 |