| NPI | 1164767323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT019049) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070019600) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2021-03-31 |