| NPI | 1104044122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 7696) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 70015562) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2017-11-29 |