| NPI | 1104116961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.018349) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014375) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2018-05-10 |