| NPI | 1972085157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070024134) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23916) |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2019-01-18 |