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 |