| NPI | 1114984762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT009548) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070014286) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2022-04-21 |