| NPI | 1083843676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2005005734) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070015499) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2009-07-06 |