| NPI | 1083761001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-012367) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT-003999) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-08 |