| NPI | 1255719233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070019965) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1257159) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2018-02-18 |