| NPI | 1235460684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: IL 212000089) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IL 227001243) |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2010-05-05 |