| NPI | 1144361015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-04998) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070012819) |
| 225100000X Physical Therapist (Licence: MO 2015003684) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2015-04-24 |