| NPI | 1982157202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.029183) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210863) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2025-12-08 |