| NPI | 1275919136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070022124) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501017277) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2019-11-01 |