| NPI | 1164457107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 01854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070008908) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2009-12-18 |