| NPI | 1245457241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 02132) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.006674) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2007-07-08 |