| NPI | 1144210998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-004975) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 7399) |
| 225100000X Physical Therapist (Licence: WA PT00006569) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2008-02-14 |