| NPI | 1306183587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0009468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070019631) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2013-01-09 |