| NPI | 1265749212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070019641) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8610) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2022-07-21 |