| NPI | 1205057452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017156) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070015131) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2024-06-01 |