| NPI | 1972837789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: WI 10470-146) |
| Additional Taxonomies | 226300000X Kinesiotherapist (Licence: IL 1804) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2022-06-13 |