| NPI | 1043277155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 02562) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-008667) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2013-09-23 |