| NPI | 1023287729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11899-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-016213) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2011-12-20 |