| NPI | 1235561986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011217A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.020408) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2018-07-24 |