| NPI | 1952857690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-026361) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 003676) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2022-01-04 |