| NPI | 1063844124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12351-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-019941) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2021-09-09 |