| NPI | 1104350321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35994) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070014826) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2017-04-13 |