| NPI | 1316389133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-019956) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 8550399-2401) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-08-06 |