| NPI | 1235493644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1274856) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070014894) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2018-11-07 |