| NPI | 1164899902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070021869) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25652) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2015-11-02 |