| NPI | 1285670372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.018867) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05001006A) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2015-07-09 |