| NPI | 1306259767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 072983) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.020186) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2014-06-03 |