| NPI | 1134540735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.022299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1235046) |
| 225100000X Physical Therapist (Licence: AZ LPT-30408) | |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2019-01-24 |