| NPI | 1952964686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070025646) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0018167) |
| 225100000X Physical Therapist (Licence: MA 25828) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2025-02-19 |