| NPI | 1134357205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38666) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: IL 070017400) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2022-07-13 |