| NPI | 1063497055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 7328) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070012142) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2007-10-09 |