| NPI | 1164418117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 03072) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070011980) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2013-01-08 |