| NPI | 1104114610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2011021995) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.018458) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2011-07-18 |