| NPI | 1306383773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070021987) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5069) |
| 225100000X Physical Therapist (Licence: MO 2015027077) | |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2017-01-24 |