| NPI | 1154461101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.017011) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL-4591) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2011-11-24 |