| NPI | 1063640134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11862-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-017222) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2017-04-19 |