| NPI | 1134133515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05001152A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070002318) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2012-11-02 |