| NPI | 1114213196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-019688) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MO 2011019590) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2013-01-29 |