| NPI | 1225142631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 1954) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT00255IL) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2015-07-30 |