| NPI | 1982398442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 1108015) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070027520) |
| 225100000X Physical Therapist (Licence: MO 2025044630) | |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2025-10-27 |