| NPI | 1275998932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070022267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209986) |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2016-10-19 |