| NPI | 1124316492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12669-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070018615) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2019-02-25 |